Insomnia

Many cancer patients have trouble sleeping. Sleep problems, such as lack of sleep or sustained tiredness, can hinder cancer recovery. It can also worsen cancer-related symptoms or side effects of treatments.

Insomnia refers to the frequent occurrence of sleeping problems, and the recurrence of the following symptoms that affect daily life:

• Difficulty in falling asleep
• Inability to fall asleep throughout the night
• Waking up several times at night
• Waking too early and having difficulty falling asleep again
• Feeling tired after getting up
• Feeling tired during the day, being unable to concentrate and being easily irritated
• Often worried about the consequences of insomnia

• Physical symptoms such as pain, shortness of breath, cough and nocturia
• Problems with circadian rhythm (Biological clock)
• Stress or emotional distress, such as anxiety and depression
• Stimulants such as alcohol, caffeine, and nicotine
• Urinary problems
• Delirium or delusion

Other factors affecting sleep quality include:  

• Inactivity: Patchy and less refreshing sleeps
• Poor sleep environment: Temperature, light or noise
• Using digital devices with LED screens right before sleep
• Using bedroom for other activities, such as working and  playing video games
• Other medical conditions: being overweight and allergies can affect breathing
• Heavy alcohol and caffeine use in the evenings or large late meals
• Disturbance by other people, neighbours or pets
• In case of any symptoms, one should notify their healthcare team for a follow-up as soon as possible

Insomnia may be treated by medications, either to address the insomnia or to address its cause. For example, if pain is causing sleeping problems, medications for relieving pain may be prescribed.

Lifestyle modification is always the first management for insomnial. If it doesn't work, you can consult your doctor for prescription of medications. There are side effects associated with taking these kinds of medications for long periods of time. In general, they should only be taken for 2 to 4 weeks. You need to avoid alcohol and some other medications while using them. Talk to your doctor if you have any queries about your medications.

These steps can improve sleep after cancer treatments:

• Stick to a Schedule
  1. Go to bed 7 hours before you want to wake up or 17 hours after you wake up. Same time every night. Irrespective of how many hours of sleep you had or how tired you feel get up 7 hours after you go to bed.
  2. Avoid lying in bed or napping for more than 20 minutes during the day.
• Improve Sleep Hygiene      
  1. Use the bedroom for sleep and sex only
  2. Develop a pre-bed routine: For the hour before one goes to bed:
     1. avoid using digital devices except the TV.　
     2. have a small, warm carbohydrate drink 1 hour before bed.
     3. take a warm shower,
     4. ensure the bedroom temperature is cool, 16-23°C is best,
     5. block external light and ensure silence and darkness. Get into bed and immediately switch off the lights.
     6. Find a comfortable position and lay still for 10 minutes. Use the same position nightly.
     7. Relax all your muscles and think about peaceful and nice things
     8. If worrying or intrusive thoughts occur, just observe them, but do not react to them. Remain relaxed and calm. One should soon sleep.
• Try Relaxation Techniques
  • If one does not sleep after 20 minutes in bed, or wake in the middle of the night for over 20 minutes:
    1. Get out of bed and immediately leave the bedroom.
    2. Sit quietly or read relaxing material, excluding no digital devices or exciting TV shows.
    3. Keep a relaxed and calm mind
    4. Quieten oneself and relaxing one’s body
    5. After 10 minutes of relaxation, return to bed in the starting position while staying still and relaxed.  Repeat as needed. Get up at the original time.
• Brisk Physical Activities for at least 15 minutes each day
• Reading tire the eyes and cause sleepiness

Allow 1-2 weeks time to regain good sleeping habits. One should be patient and follow these guidelines, particularly the time to bed and time awake. 

The Institute of Mental Health, Castel Peak Hospital: Mental health information (Chinese version only) 

HKUMed, Jockey Club Institute of Cancer Care: Improving sleep quality after cancer 

Smart patient (by Hospital Authority): Insomnia